Provider Demographics
NPI:1225137086
Name:THOMAS, DOMENIC JOSEPH (LAC)
Entity Type:Individual
Prefix:MR
First Name:DOMENIC
Middle Name:JOSEPH
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 HARFORD RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3123
Mailing Address - Country:US
Mailing Address - Phone:410-882-4852
Mailing Address - Fax:410-882-4853
Practice Address - Street 1:9403 HARFORD RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3123
Practice Address - Country:US
Practice Address - Phone:410-882-4852
Practice Address - Fax:410-882-4853
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG733-0001OtherBLUECHOICE PROVIDER #
MDBN99DJOtherCAREFIRST BC/BS OF MD